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Home My WebLink AboutBERNARD BLK 3 LT I-1BBernard Block 3 Lot I-iB #060-321-16 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211468 PID Number: 060-321-16 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name JUSTIN MARTIN ABSORPTION FIELD Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 8164 STEWART MOUNTAIN, EAGLE RIVER, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2 Ft. Gravel depth beneath pipe 6 Ft. Subdivision Block Lot BERNARD BLK 3 LT 1-16 Fill added above original grade 1 Ft. Gravel length 33 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From I Tank Field Tank Line 396 Ftz 1 Ft. Well 1 100 100'+ 501 f TANK ❑p Septic ElS.T.E.P. ❑ Holding [:]Other Manufacturer Capacity GREER TANK 1000 Gal. Surface Water 10Q'+ 'j Q�'+ ! Material PLASTIC Number of compartments 2 Lot Line 01+ 10'+ NA Foundation Q'-} Q' i LIFT STATION Manufacturer Capacity i Remarks TANK DECOM. PER UPC. Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer MIKE N ANDERSON, P.E. Drainfieid 3034 CO/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 108 ft Inspection n 1 6/11/21 2nd 6112/21 Location and description dates: TOP OF SEPTIC MANHOLE 3b 4'h ON-SITE WATER AND WASTEWATER SECTION APPROVAL E"$'�ep 4 0 • A�ipa Conditional Approval: Date ,,;''^�� •' • • e'�� `4; *:'4 9 1—H •• MICHAEL N. AKDERSON•:d` P� f1 •, CE 946 Septic System Approve Date Z� • ��?r llF•Z��'<, Note: this approval does not include well permit requirements. (Kev U5/U1/1b) Permit No. OSP201458 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: BERNARD BLK 3 LT 1-18 PID No.: 060-321-16 MARK A B 001_ 36 CO2 37 49 TC01 42 51 TOC2 51 CO3 46\ 50 I C04 47 \ 50 MT 78 82 C05 64 \Z5 I C06 90 9Q I I I �I �TH#t - \ i • \I / / - - -I C05 - 6 l I I i I ; • to OAF • C - / 1\ SEPTIC I \ � BENC TOP OF Nf\ <} \ MEW 10 GALLOWFL-ASTIC Tom, NKA \ 100' 0 FSET\ I CRFIEK I I \ \ I I I \ \ I (DWELL (DWELL I I I \� ASBUTLT---_ —�\ \ SCALE: 1 "=50' \ / 108 CD, CO2 TCO2 CD3 1:04 Cos C08 OF TCD, 1 .•'\P ..•• •� De [A : �.•' 49 TH Fl11R FABRIC , SEPTIC SECTION DRY JUNE 2021 N.T.S. -1 0 ,Z �) ;MICHAEL N. ANDERSON: =. No. CE 9469 ' 6AV —25-21 Municipality of Anchorage Development Services Department �•``,•'• . rf- on-Site Water and Wastewater Section 4700 Elmore St. ; • 49TH ypr� P.O. Box 196650 Anchorage, AK 99519-6650 • • " • • • • • • • . .... , , www.muni.org/onsite • • �a e (907) 343-7904 •' • • • • F✓ • MICHAEL N. ANDERSCN Soils Log - Percolation Test ��f��I,z�4�-z:{•'� Performed For: H Date Performed:�— Legal Description: VJCnc'tyA' Pl �L' 3 L-y�1%(I>Township, Range, Section: Cf E � 2- 1- Date Qs - 2- Depth to Water Net Drop 3- 3- 1p/ 5 L 4- 4- " �-- 0 5- 5- f P 6- 6- E 7- 7 -8 2 { 8- -9- 9- 10- 10- >> it 11- 11- 12- 12- 13- 13- 14- 14- 15- 15- J 16 -J 16- 17- 18- 19- 20 - COMMENTS Site Plan WAS GROUND WATER Date Gross Time ENCOUNTERED?�J Depth to Water Net Drop IF YES, AT WHAT DEPTH? 1p/ 5 L Depth to Water After " �-- 0 Monitoring? f P E Date: 2 { Reading Date Gross Time Net Time Depth to Water Net Drop t �r >> it o�orni n J ---..__....... — car I t -LM, MULE UTAMETER (-,p TEST RUN BETWEEN .-S FT AND Tyr �" FT PERFORMED BY: (..I( 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ( 2 7,/ MUNICIPALITY OF ANCHORAGE Onsite Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://w .muni.orglonsite On -Site Wastewater Disposal System Permit Permit Number: OSP201468 Work Type: Septic Upgrade Tax Code Number: 06032116000 Site Legal Address: BERNARD BLK 3 LT 1-1 B G:0254 Site Mailing Address: 8164 STEWART MOUNTAIN DR, Eagle River Owner: MARTIN SABREENA & JUSTIN Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 1,enr Department 11/24/2020 11/2412021 38222 El Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: A test hole is required prior to construction, in location shown on site plan, to confirm minimum separations to impermeables and seasonal high groundwater, as well as to confirm percolation rate. Construction may proceed at your own risk prior to 7 -day groundwater monitoring. If results require a design change, construction shall stop pending review & approval of a change order. Please submit results with inspection report (or change order, if required). Received By: Date: Issued By: Date: %� 0 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 060-321-16 Property owner(s) SABREENA & JUSTIN MARTIN Day phone Mailing address 8164 STEWART MOUNTAIN DR, EAGLE RIVER, AK Site address SAME Legal description (Sub'd., Block & Lot) BERNARD BLK 3 LT 1-1 B Legal description (Township, Range & Section) Lot Size 38,222 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank R Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: �` q, -) (60 V, t Date of Payment: 1 Q 3© gy'�_ U Receipt Number: 0 555 Permit No. © S P 2- 0 19 (� g Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201468, Rebecca Carroll, 11/24/20 Nov. 24, 2020 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic permit Legal: BERNARD BLK 3 LT I -1B To Whom it may concern: This is a request for a septic permit on the above referenced lot. A single test hole revealed poorly graded gravels (GP) for the entire 17 foot depth with no water during or after the 7 day monitoring period. The soil perc rate was 2 minutes per inch. Due to the creek easement on the west side and the 100' off -set requirements a new test hole will be done prior to the excavation of the system. A new 1000gallon plastic tank will be installed with a simple gravity flow deep trench system, see site plan. The slopes around the proposed site is less than 4:1 with no cut banks or steep slopes within 50 feet. This new system will not impact any of the neighbors or encroach on any wells, septic or open water issues. Sincerely /A/ Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 DESIGN CRITERIA: 3 BDRM X 150 = 450 GPD SOILS = 450/1.2 = 375 SQ FT REQ'D 375/2(6.0) = 32- (1)TRENCH 2' (1)TRENCH 8' DEEP 6.0' EFFECTIVE 2.0' WIDE 32' LONG -17' On-site Water and Wastewater \05 01466,, Rebecca Carroll, 1 /FILTER FABRIC & INSULATION --4"0 PIPE SEWER ROCK SEPTIC FIELD SECTION I II — BERNARD DRIVE- \ � I \RTMp��T l� PROPERTY LINE EXISTING \ DRAINAGE FIELD EXISTING HOUSE EXISTING WELL 100' RADIUS Septic Design Prepared for JUSTIN & SABREENA MARTIN BERNARD BLOCK 3, LOT 1-1 B Michael N. Anderson, P.E. DATE: 4601 NATRONA AVE D RAW N : ANCHORAGE, ALASKA 99516 (907) 345-3377 / FAX: (907) 345-1391 SCALE: OFA'11 AV A 49 TH + r 10/29/2020 #'. *# N. ANDERSON; '. *# No. CE 9469 .•'�� DJR 1 "=200' ��._ESS\•i��• OR 2.0 0 GP co -8.0' z.o' On-site Water and Wastewater \05 01466,, Rebecca Carroll, 1 /FILTER FABRIC & INSULATION --4"0 PIPE SEWER ROCK SEPTIC FIELD SECTION I II — BERNARD DRIVE- \ � I \RTMp��T l� PROPERTY LINE EXISTING \ DRAINAGE FIELD EXISTING HOUSE EXISTING WELL 100' RADIUS Septic Design Prepared for JUSTIN & SABREENA MARTIN BERNARD BLOCK 3, LOT 1-1 B Michael N. Anderson, P.E. DATE: 4601 NATRONA AVE D RAW N : ANCHORAGE, ALASKA 99516 (907) 345-3377 / FAX: (907) 345-1391 SCALE: OFA'11 AV A 49 TH + r 10/29/2020 #'. *# N. ANDERSON; '. *# No. CE 9469 .•'�� DJR 1 "=200' ��._ESS\•i��• On-site Water and VI REVIEWED FOR CODE OSP201466,, Rebecca �STF�gRT PELENOR BLOCK 2, TRACT F-2 u ----, ` j NEW TEST HOLE \\` I 1100' CREEK OFF -SET co REQUIRED PRIOR ` I TO EXCAVATION BERNARD ` I BLOCK 3, LOT 3 PROPERTY LINE�-TH#2 Lu 1000 GALLON --�a#1 � l i v BERNARD I PLASTIC TANK W/ �� 1 1C0 a BLOCK 3, LOT 1-1A I 20" RISERO Co J `\ I I I a DCO / I SEPTIC I I i I ; DCjO `N NEW SYSTEM TO BE PARALLEL TO SLOPE VACANT 1 o EXISTING TANK & FIELD TO BE COQ �9� �'DECOMMISSIONED \� PER UPC \ \i DRAINAGE/CREEK RUNOFF / \ EASEMENT BERNARD \ / BLOCK 3, LOT I -1B \\ 1 I\ \ I II WELL WLL ® I I \ \ I ®I I \ 1 I \ \ I BERNARD BLOCK 3, LOT 10 Septic Design Prepared for JUSTIN & SABREENA MARTIN BERNARD BLOCK 3, LOT I -1B Michael N. Anderson, P.E. DATE: 10/29/2020 4601 NATRONA AVE DRAWN: DJR ANCHORAGE, ALASKA 99516 (907) 345-3377 / FAX: (907) 345-1391 SCALE: 1 "=50' i i i WOW 49 TH * \ '.,MICHAEL N. ANDERSON; No. CE 9469 %0-30-20 ° i Municipality of Anchorage Development Services Department On -Site Water and Wastewater Section 4700 Elmore St, P.O. Box 196650 Anchorage, AK 99519-6650 WWW.muni,orci/Onsite (907)343-7904 Municipality of Anchorage On-site Water and Wastewater ^� REVIOWD:. ,CODE COMPLIANCE 89144,, Carroll, 11/24/20 -� (ENGIA. SEAj_),,. ,<! .°.......:.°....... tt Soils Log - Percolation Test Performed For: Date N 4,+1 y V"/ T yn y Date Performed Le al cription: � f n Or 4 � � �, � - Township, Range, Section: depth (Feet) 2- 3- 4- 5- 6- 7- 8- 9- 12- 13- 14- 15- 16- 174---4- - 3- 4- 5- 6-7- 8- 9- 12- 13- 14- 15- 16- 17 18- 19- 20- 18- 19- 20 - COMMENTS COMMENTS WAS GROUND WATER ENCOUNTERED? I� Q 1F YES, AT WHAT DEPTH? Depth to Water After Monitoring? Date: s L O P E Site Plan G© IN Reading Date Gross Time Net Time Depth to Water Net Drop to LS' PERCOLATION RATE C/ (minuteslnch) PERC HOLE DIAMETER �LP TEST RUN BETWEEN Z FT AND�jj FT PERFORMED BY: M ,^% A, I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: it (1/ tD N6q , qRT MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 060-321-16 ANCHORAGE Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: Phone: 907-343-7904 Fax: 907-343-7997 Complete legal description BERNARD BLK 3 LT 1-1 B Location (site address) 8164 STEWART MOUNTAIN DR, EAGLE RIVER AK Current property owner(s) SABREENA & JUSTIN MARTIN Day phone Mailing address SAME Real estate agent 2. TYPE OF DWELLING: F71 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well [X Private Septic F. Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. is _/ / C "'. ce, S-7-7 -F vs COSA Fee $ D %-7 r rw r �l Waiver Fee $ Date of Payment I 1 I Z 512,020 Date of Payment I Receipt Number o 2 s 1 i 7 Receipt Number COSA # nV_ --d 1 (v 577 Waiver # STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. 6. DSD SIGNATURE 2�? �21 _4K System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Phone 727-8864 Date 11-5-20 s� C1=�r,*r�N A r •. MICHAEL N. A,%;0ERSGN 94,9s By:r,z—f4iOriginal Certificate Date: -LL— 1— I q— 2 20 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: BERNARD BLK 3 LT 1-1 B If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6111/06 Total depth 160 ft Cased to 60 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 8/14120 Static water level at beginning of test 30 ft. Comments B. TANK DATA Age of tank(s) new years Tank type/material Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) new ❑ ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade 3 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 060-321-16 Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate 1.76 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 8/14/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date new Results QPass For 3 bedrooms Fluid depth prior to test in Water added new gal New depth in Elapsed time min ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required- if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _ date of test)If yes, enter date 0 Gallons introduced gallons Comments/Deficiencies.- COSA omments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Q✓ Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft (�✓ Yes if No ft Neighboring Tank > 100' P/ Yes if No ft Private Sewer/Septic Line > 25' Q✓ Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' ❑✓ Yes if No ft Water Main > 10'✓1 Animal Containment > 50' Q✓ Yes if No ft M Yes if No ft Yes if No ft Water Service Line > 10' Q Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community .Sewer Main > 75' ED Yes if No ft ✓E Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' Q✓ Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10'✓1 ft Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' Q Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells? 100' ❑✓ Yes if No ft; Water Service Line > 10' Q Yes if No ft Community Wells > 200' El Yes if No ft Surface Water > 100' ✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet 49TH r6r, f �a aattatr: ♦1 r �.ws-t' #' • Olt at at P: mv �� ws �+•I •II � .cl+' "'( Ar o OF A�q�;4p �:: 49 TH o .:.< p ° N 89 56' 30" E 124.59 SHANE A. HOLT �O J p LS -6914 0` O P 5 o AS-BU/L T SURVEY f"= 30' ��4A ofessionat 40�000��0 NO CORNERS SET THIS LATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOTI-78, SLOCK3, 6ERNARDSUB.. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE HE LNFCR rT1oN ;1E RE OH IS -OH ?HE uSE of LEND IIaG IrtSTITurIONs saECla;cr..LLr TG SHOW ANv VISIBLE L'dPROVEtdENTS SITUATED THEREON ARE WITHIN oNTLIc.'rs BETWEEN EXISTING STRUCTURES ANo PLATTED LOT LINES ANDIOR EASEMENTS; AND zs THE PROPERTY LINES AND NO VISIBLE EfdCROACHh1'eNTS NGT TO HE USED FOR POS IT ZONIt4G F,DEITIDNAL STRUCTURES, IS?PRC«EMENT<., OR Fc'NCELI NES. EA EN NTS OF ftECCRD, GR ANY LEGkL ENTITY, OTHER THAN TiiOSE APPEARING ON THE RECORD PLAT EXIST OTHER THAN NOTED. AR raor SHCWr: HEREON( UNLESS INOICATEDi DATED AT ANCHORAGE,ALASKA THIS 23 RD DAY OF Ncl PENCELINES TNA' NAY APPEAR ON THIS DRAWING ARE HOT TO 3C- USED TO DETERHNE JUNE , 2021 PRorEk TY LS NES OR POSITION ADDITIONAL IMPff CVEMENT S. ANY PAVING SHOWN HEREON NAY BE AP P ROXi NATE DUE" TO EXCESSIVE SNOW AND!OR ICE. HOLT LAND SURVEYING TIESU.4/YDATAONT[115DRA/ONG I5 PREPARED FOR THE OWNER OFRECORD OM Y 9309 GROVER DRIVE fJYCOPY/l ;, ORUf,'IlZ,'6THEDATAI%EREONlSP.40H/IiITEDUNvfl?COPYRICNTIAW ANCHORAGE,AK 99507 .._....... . 4840, F8 209-32,274-29 345-5513 n✓6 t-� ` TE�gRT ---------------- MOUNTAIN — --DRIVE-_- 1 — L 162.99 --------------- -- t i ri z; 1 I � i NJ ° tVA j!:A VAI'V,� 4 o OF A�q�;4p �:: 49 TH o .:.< p ° N 89 56' 30" E 124.59 SHANE A. HOLT �O J p LS -6914 0` O P 5 o AS-BU/L T SURVEY f"= 30' ��4A ofessionat 40�000��0 NO CORNERS SET THIS LATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOTI-78, SLOCK3, 6ERNARDSUB.. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE HE LNFCR rT1oN ;1E RE OH IS -OH ?HE uSE of LEND IIaG IrtSTITurIONs saECla;cr..LLr TG SHOW ANv VISIBLE L'dPROVEtdENTS SITUATED THEREON ARE WITHIN oNTLIc.'rs BETWEEN EXISTING STRUCTURES ANo PLATTED LOT LINES ANDIOR EASEMENTS; AND zs THE PROPERTY LINES AND NO VISIBLE EfdCROACHh1'eNTS NGT TO HE USED FOR POS IT ZONIt4G F,DEITIDNAL STRUCTURES, IS?PRC«EMENT<., OR Fc'NCELI NES. EA EN NTS OF ftECCRD, GR ANY LEGkL ENTITY, OTHER THAN TiiOSE APPEARING ON THE RECORD PLAT EXIST OTHER THAN NOTED. AR raor SHCWr: HEREON( UNLESS INOICATEDi DATED AT ANCHORAGE,ALASKA THIS 23 RD DAY OF Ncl PENCELINES TNA' NAY APPEAR ON THIS DRAWING ARE HOT TO 3C- USED TO DETERHNE JUNE , 2021 PRorEk TY LS NES OR POSITION ADDITIONAL IMPff CVEMENT S. ANY PAVING SHOWN HEREON NAY BE AP P ROXi NATE DUE" TO EXCESSIVE SNOW AND!OR ICE. HOLT LAND SURVEYING TIESU.4/YDATAONT[115DRA/ONG I5 PREPARED FOR THE OWNER OFRECORD OM Y 9309 GROVER DRIVE fJYCOPY/l ;, ORUf,'IlZ,'6THEDATAI%EREONlSP.40H/IiITEDUNvfl?COPYRICNTIAW ANCHORAGE,AK 99507 .._....... . 4840, F8 209-32,274-29 345-5513 C "j 1�-( 0-"4 C 0 C_� Ft MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 060-321-16 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: Complete legal description BERNARD BLK 3 LT 1-1 B Location (site address) 8164 STEWART MOUNTAIN DR, EAGLE RIVER AK Current property owner(s) Mailing address Real estate agent SABREENA & JUSTIN MARTIN SAME 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request far: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ g %- 0 C�.WLf v� r1.111` Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA # nLC 2-01 Co 57 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name 6. DSD SIGNATURE MIKE N ANDERSON, P.E. System #1 Approved for 3 System #2 Approved for Disapproved _4 — Conditional approval for 3 bedrooms bedrooms Date 11-5-20 Ar p • . .. ... • MICHAEL N. A,':JLRSCN �,7?0- "'5 id. y I ri•:.4 � bedrooms, with the following stipulations: �% %-%'*.,%. By: f4j Original Certificate Date: 2t{- 2 2b The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: BERNARD BLK 3 LT 1-1 B If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6""06 Total depth 160 ft Cased to 60 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 6/14/20 Parcel ID: 060-321-16 Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1.75 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample anaizo Static water level at beginning of test 30 ft. Comments * conditional permit, new test to done at final cosy B. TANK DATA Age of tank(s) new years Tank type/material new Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA new system w/ conditional Which system tested (date installed) new ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 0 gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results P/ Pass For 3 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft M Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' [Z] Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No ft F-71 Yes if No ft if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft ✓Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100' [✓ Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 51 F1 Yes if No ft Private Wells > 100' Q✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓� Yes if No ft Wells on Adjacent Lots.- ots:Water WaterMain > 10' ✓l Yes if No ft Private Wells > 100' Q✓ Yes if No ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet Nov. 25, 2020 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Conditional Request Legal: BERNARD BLK 3 LT I -1B To Whom it may concern: This is a request for a conditional COSA on the above referenced lot. The granting of this conditional request will have no eminent health hazards, no overflowing sewage or signs that the tank is collapsing. I certify that there will be no adverse effect as a result of the granting of the conditional approval. Sincerely /17;W, Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 07/25/2007 10:50 6882259 SULLIVAN ' Certttteb titling log by DOC CO. dos SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 •TELEPHONE 688-2759 OWNER OF LAND. koY momits ADDRESS' LEGAL DESCRIPTION: ArtiCA.14(0 me 3 Or I..., DATE: 6//V!O PERMIT NUMBER: PAO /3c TM IDENTIFICATION NUMBER: , 06 0-- 7,2 Is well located at approved permit location? ti..Yes 0 No Method of Drilling: blirreotary O cable tool Depth of well: /6 D Date of Issued -{Z -di) %b Casing Type crEE4 Watl Thickness Inches feet Diameter 6 // inches, depth 6 0 Liner Type: nit) NE Casing Stickup Above Ground. Static Water Level: 3 y a. Recover Rate: 30 gpm Method of Testing' /l//E feet feet Well Intake Opening Type: O open end 9st/dgri hole O Screened; start O Perforations Start Grout Type: aF.,I ra •+JSTc Depth: from C7 feet Stopped feet Stooped Va'u'e otume feet to el o Well Disinfected Upon Completion? 6arri 0 No Method of Disinfection' em e,ri.4 c fl "Pm • feet feet feet Comments: BORE HOLE DATA DEPTH Far. To D a 1 /1 1) S'1 S/ /2? /aV /3 5- 13.5" 1337 /47 /t 51 Ila PAGE 01/01 C4,reta 4 <S-- /c4c Lie i7 tiCCAJd4sr.J aeGr/..!/GS 13'04 o G at?!L« r /? Edea c x /3x a Lai AJ Fj?/Fcrc1aQ#r/f age -91c it. 640Y r' 6,cit Ao ct6 GRAY gdAt7W - atoe7 eicat'a crc 6214) Driller's Name ei'/tc. 81/4 c 4 /ne4 ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough: Department of Environmental Conservation. ARCTIC PUMP & WELL INC. Jim Sullivan PO 13ox 770197 Cagle River, AK 99577 (907) 688-2510 (907)258.2510 (907) 745-2510 pmr ieci.net Pump Installation Log Well Drilling Permit Number: SW060130 Parcel Identification Number:060-321-16 Date of Issue: 6-06-06 Legal Description:Bernard Lot: I -1 B Block:3 Property Owner Name & Address: Roy Thomas POBX772026 Paola River AV O0G77 Pump Installation Date: 7-6-06 Pump Intake Depth Below Top of Well Casing:136 Feet Pump Manufacturer's Name: Dempster Pump Model:MBF2-75-S2 Pump Size:3/4 hp Pitless Adapter Burial Depth:10 feet Pitless Adapter Manufacturer's Name: U/K Pitless Adapter Installer:U/K Arctic Pump & Well, Inc. Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump R Well. Inc. Page 1 of l MUNICIPALITY OF ANCHORAGE Development Services Department On -.Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Jun 06, 2006 Expiration Date: Jun 06, 2007 Permit Number: SW060130 Parcel ID: 060-321-16 Legal Description: BERNARD BLK 3 LT I-1 B Design Engineer: 0000 None Required Site Address: Owner Name: ROY J. THOMAS Lot Size: 38222 SQ. FT. Owner Address: PO BOX 772026 Total Bedrooms: 3 Permit Bedrooms: 3 EAGLE RIVER , AK 99577-2541 This permit is for the construction of: p Disposal Field ❑ Septic Tank ❑ Holding Tank 0 Privy ❑✓ Private Well 0 Water Storage All construction must be In accordance with: 1. The attached approved design. 2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by catling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55. PLEASE SEE THE ATTACHED SHEET "PERMIT REQUIREMENTS FOR A PRIVATE WATER WELL". IT IS THE BURDEN OF THE PROPERTY OWNER TO DETERMINE THAT THE PROPOSED WELL WILL NOT HAVE ANY ADVERSE IMPACTS ON ADJACENT WELLS OR SEPTIC SYSTEMS AND DETERMINE ANY EXISTING WASTEWATER PERMITS EFFECT THE LOCATION OF THE PROPOSED WELL. IF THERE ARE ANY QUESTIONS, PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER PROGRAM AT 907-343-7904. Received By: Issued By: Date: G-tr(0 /r �(lMt4`rt�.yv Date: 6-6i-06 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. OGD - 32.1 ^ Ik Property owner(s) • Rny .1. �tkohk4 Day phone 4LF5 AS Mailing address V Ili _• , .' - . = , 2.k Zip Code TIG17 Site address 9uak gi wK'21. FAIR. -DP-'012 Elft 120Ut ip Code TISil Legal description (Sub'd, Block & Lot) 8GVs D ELIC 31 f 1-(13. Legal description (Township, Section & Range) Lot Size 3$1 2 2.2- Sq. Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR (®all that apply): THIS APPLICATION IS AN: Absorption Field 0 Initial 0 Septic Tank 0 Upgrade 0 Holding Tank 0 Renewal 0 Privy 0 Private Well Y1 Water Storage 0 I certify that the above information is correct. 1 further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. 51 vla(c, property owner or authorized agent) Permit/Rush Fees:� Waiver Fees: Date of Payment: 57.31 0 - Date of Payment: Receipt Number: O 06 Receipt Number: (Rev. 11/05) x..07 j-st3 Stoat_ 3 �ER11kPt> S SbtD itlOKI cis( lttott&g W�u 14114,l,OCIab WELL ?EMT -MT. Mood TktM$ loc caort 5-30-o6 xeNtel s�PT�. 515� rani' • DMwu4 _ L •V 1 LoT 1-1A ...cr.09 • • Li)," "0"' ,dot. •••••. tor 710) WSW ir ~AU 1\0/ II <NDE 1.Oftb" oa 11 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Permit Number: SW040280 Legal Description: (BERNARD BLK "3 LT I-1 B' Design Engineer: 0000 None Required Owner Name: ROY J. THOMAS Owner Address' 8164 STEWART MOUNTAIN DRIVE EAGLE RIVER , AK 99577-2541 Date Issued: Jul 22, 2004 Expiration Date: Jul 22, 2005 Parcel ID: 060-321-16 Site Address: Lot Size: 38222 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, seated, and heated to prevent freezing. 5. The following special provisions. THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55. PLEASE SEE THE ATTACHED SHEET "PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM". IF THERE ARE ANY QUESTIIONS PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER PROGRAM AT 907-343-7904. Received By. Issued By: Date: 143/0 f Date: 1/& Jr f4 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0(00 - 321- 1(0 Permit Number SW Property owner(s) IHonAS Day phone 2to5-7.5to Mailing address (1) Pc Box '1'l?ofo Ekon RtVtR t& `196'11 i5vta t ig address (2) $ IU4 Slethedimnit nl8Ln QVItJet) Zip Code GSISI Legal description (Lot, Block & Sub'd.) t -o -C 1- 1F, . 2 aoc-lc 3 , 3eR aKO- Sve.bn,/ totJ Legal description (Section, Township & Range) 5iaCT, .1 tick TewNSHIP (J4- NBR7K, 12kJac,e t WEs, Lot Size 3?;,22-2. Acres THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade Number of Bedrooms 3 ❑ Well Only ❑ Water Storage 0 THIS PROPERTY CONTAINS: Hot Tub 0 Swimming Pool 0 Therapy Pool ❑ Jacuzzi Water Softening Unit 0 I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (SigddtJt of p operty owner or authorized agent) Permit Fees: f ?TA' Waiver Fees: Date of Payment: ?Pvfvy Date of Payment: Receipt Number. Cc ? S 1 (Rev. 12/00) Receipt Number: • Col Suvk 3 Issik-Lb susbmskog sertviterno9tgrbin gal lietotikt \NELt. Pcianir 1 -t, -o4. '91•••••• L oT 9 ' NIDENIadftb\ 11 ��\ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION s.� 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME_ 1 home, .ec PHONE NEW ❑ UPGRADE MAILING ADDRESS SV-.--- 2. b 9L/ 0-kucci Ink f . q95-67 LEGAL DESCRIPTION , Birncirct nut. IkcI-Cc,tS i -' a) LOCATION MIL 2 i--1; lard 8 . NO. OF BEDROOMS SEPTIC TANK DISTANCE TO: II p Absorption area prturfiLitlI S � Dwelling PERMIT NO. �� Manufacturer ,tiCh or 9Q � J Materiafthe J No. of compartments Liq. capacity in gallons 11000 IF HOMEMADE: Inside length ...._ Width Liquid depth CS JAZ 2 z 4 DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons TILE DRAINFIELD TRENCH DISTANCE TO: Well h �..Q'(7' ryiLd�nit Foundation Nearest lot line 50 PERMITO Q' 0 3 6 1 No. of lines 1 Length of each line 41 Total length of lines 2/ Trench width il illtifoinches Distance between lines ---� Top of tile to finish gradeMaterial y beneath tile 72 inches' Total effective absorption area 8 SEEPAGE PIT Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J J w Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption areals) OTHER i-1) ti ^ ' �I' 1d d . PIPE MATERIALS PVC - SOIL TEST RATING 1?5 rte' /act rnn 50 INSTALLER LO �j s, ") REMARKS _04 _04 CAVA- Tloh TANk t ,i - \S. ti APPROVED DATE LEGAL 7— 42 . 8-'d1 2 //C . 7 72-013 (Rev. 3/78) ��IHO: 'IF" Ft 1...._ I "T- v of F,--. FA r4 I:AA r.1 IR Fli GIE.:.. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 ' STREET, ANCHORAGE., HK 9' 1 264-4720 OP-4__�,:ITE:7.. :SEE.WEEIR F�EFRMI.-T PERMIT Na ( 820367 ) l APPLICANT H[METEK LOCATION HILHND RD • LEGAL L I -1B B] BERNARD S/D CR'D BnX 5974 CHUGIAK AK 99567 688-2052 TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH LOT SIZE ]8222 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS - ] SOIL RATING (SQ FT/BR)= 175 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: CREFFY-11-11= :ILO E..E.WCYTH= 4-4 ��VELAL.. ��F:'"1""1-1= *15 -- THE THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET THERE IS NO SET WIDTH FOR TRENCHES THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). FREDIDUIEEIDI SAEF"-FIN"...3: "1-FIWK �I---E77.= �kDelet OFIL.P_OP-A� • PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE • NUMBER OF RESIDENCES THAT THE WELL WILL SERVE ___ -TWO <2-:::.) IINVE5F'EMICHINIS.: .PIET. F.,!EFENDUIF:EHICA , BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTIM MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. �EER:MI-T �XF*IF:U.S DIEDCIEMBET.F.: ��, �L73m8:2 I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF RNCHORHGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS SIGNED:________________________________________ APPLICANT HOMETEK / x -� ISSUED BY. - �� . ^�y�� ir-E.1-711Z 3 t•ItL L;01^ H:i~Et._ Tti `1' '*1_' ' FF✓€ a r. ;_.i i•3 r & NIT NO. r Sao 7 l OCf-IT I ON H f 111-10 RO ; -1 e-: =:f IARC' 1-1F SE1' ORP r t Ott 'S'rl T:� t4 t'. : WAX f MJt4 NUMuCk +''F 'E't: otJN'a` 'Ir.' ;:t `=-{I'-#�; 3> t i `I�$ i� t, � 3' �: rte !'r,�_• 4-wu"r t;'. #' TIM " TiNCHO 1'113 =: 99:501. 'zR;;:: a=rr..JX :.w:+?$ i Hr.13 Et tFf+` 9s 6;' TRENCH 6%38 ; ;t22 `401JHn'1T 1= F.E i_iIL RRCi•ts3 <',S4O F r.i o- Le's THE REAL, ERG . IE?`s_ C3F fi 'jC'rl 165O PFIt)N r,t`= • '�r.- �i t=1.9 1-.1 - aL E i t._ ;AL1- . _i- ' - -' # # # L =t4C t t'tC t 4 I on IS THE L k rH r C t4 FEE r oF rHE TREn+ H r3 ORII l: Nt' I r t...C;►.:: r1 DEPTH )-1: t1- T 1Et:1t::H ' )R Pi T I'= r1 -3E D I •_,' rANI.:e 81.-:71,1€3=-A THE •:.1.1p r41 E OF TI par�r I1NDY} THE ) }i ti't um OF THE T y E E�N1".; = VFI T ION < IN Ft -1E r' THERE .. I*: I Wi '�. i iii .1 c i H f '.s 1 f pEtj r 3G•,. THE t RAV ' .. DEPTH I TEk. t't Etl [t'tt_!t4 DOTH IV " CARRY I_ T$'1 fit4 THet ►_t t F t,L F' Ipr 11ND THr_: tit) F TOM t tt- r! h ;t rivFf r t oN , IN tit~ r a t0 APPLIQINT 144 fl3 1:: %.Praa' r9IL LT'' TO Itl tv+€pit THIS 1st1�F tt.i_.ttrEs:t:i I ?J;". s:''t4!W i�fi '_ 8.0.JRCe'H rrs '#41-3 11.11,1SC6' Q R 3 1i 00. d'a 3'H 'r I �t-i': #•1 .2_ ?�} I # L �•t l<: �a't" . - r t.•.1i 74;e2 :71 i: 1.3 �-.f`�, t i •'_ E=. E Ng f1t't: ro4 t.'1S rHo tr F I?; Ct$' ; r it"',a4 ant? t 14..4-'t tRTP'X't?r r>.) t='P)-r::€.r. > ' I' . 1_3 F 4..-. ff., tEP R 1'M€ N 1 WRENS Ct `3 Tom:. `ROPER TY AM, THE s =; �� ` F: I fC# :iPPROVAL SY THtS N 1 IN I MOM L I'=, I #CE E1E t"W F.N 11- t+J; ,.L AND t:e410 y ?4 i its �; :t.1Fil (t' P '3'r1L SYS t`Et4 t r ,1.139 EE T FOR R PP PM TE WELL OR •.1533 TO FEF. f FROM ft PU 3t., IC WELL C.CPENC.1,114$1 t P' N rHE TYPE s',F FOOL IC WELL. f'41NIH1.1Nyy�' I))'}�.yi' Itk' t,` ' "314 11 PP ((VAfE Wht 1_ r o Fi 'RL ' `iTE SEWER L INE IS 25 FET r� fl COMMUNC y Pr ',E;t'3t-.R t,+.Etl€ S'1 ?5 FEET. t l TI-W.R. RF.01_1 I REfE.i'•IT-; (1HY f- PPLY C C r 1-'t 1=! F I OHS flHt C tJW lTRt.tt' T ION C I t 3Rlit't'5 BP RYA tL i1 t_E r'�� 1` -it PROPER IN'ST tLLHT1O 4. ✓ �-• r.:'r•i r. r=,:-:y�;r�.:-r•i:- t Ct r wFY THFir 1.: I AN FtIMELTHP WITH U -3E PEF JCF;Et'IE.t1f5 FOR ON-SITE 1::WEF7 FOR 44 e r' 1.1-11= NUM I F '1'iE_ I r t tiN 1- O TIOO.._ 2: t W ILL tN' Tt P ! Tf-#` S',"3TEM IN Ht::t_:uPLAiNC;E: W 1 TH Ci1Dir . 1 f JC•#&F.t •z 1 f tir., TWIT 114 ON -SC TE '. E i•l tti' '4 `r'' Tr ti i'IH'r' SEuL1 tRE E I C<ENr: 1.Et•iODE E TO + i. :LuDE rHaN 8 ECIRi ONS, Ft; -1NT 1-1Ot'#E #Et , O's"?:," (ANY; AND WELLS H' E111,.ARt €Hs NT V4. , PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 7Efl COMMENTS PERFORMED BY: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST ph, / �e ,r- /-c--rll e• • /04- /A ,E/ KT (cP) -/, s':// (614 Row -el ?..„..a SLOPE SOILS LOG ❑ PERCOLATION TEST DATE PERFORMED: Cifeca A/d WAS GROUND WATER i J0 L ENCOUNTERED? 'v /A Q%/tie. ° E IF YES, AT WHAT DEPTH? SITE PLAN Net • I A .�-----may 0 P1/ Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE {minutes/inch) TEST RUN BETWEEN CERTIFIED BY: DATE: [ Z� Russell Oyster 694-2774 0 & E ENC .NEERING & DEVELC MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Earl Ellis 688-2280 Performed for: Name: 5.6.4<1,4),20 tA,//i Tel. No. c754– 3 5e:35 -- Mailing Address: •7-09,e ,c'e)cfre 9/e)t9 .Z.74 / //Etc?. 471<", 993-- 7 7 Legal Description: Zor /3-ec)c_le.._ „ 5,18/7„•/.f.,/,)„./ Depth (feet) 0 1 A42. /I- 7 7i...),47 75-6 473 Soil Characteristics 2 3 cV7, -5P Pock.E. 5 Z C.;02,11/EI.../ 6 -` __Gag E 7 6/24 VL s C,7313,6 ii'(//1=-04/41 Af 45: 0 , 7: L _ - — 5 --1 9 Boot../..)ews , -----10 4-. l'--- i ts/8 --- "0 ,...z , 11 W4 6-A1,4 E 12 13 _ >e9c9 14 c;.7.--r-'t' 4 )– 15 16 PLOT PLAN 5e.41Le PERC. TEST 2 " 4 47- _ •) ••••., ,..177. I it, Ground Water Encountered: Yes_ No If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: Performed by: APPLI( NT FILLS OUT UPPER HA( ONLY Property Owner Mailing Address Iiji I .;/:z__C__ /‘,7-4 Ip Code q -V411(1 �'(CI' Phone '/ } ( � ) Buyer NI Address C »% 0/ C--- Zip Code ( t Lending Institution '� lcv1C ( 8i t- (k 4 (� CA.,_� �,. j.� Zip Code Address IV ))r Phone Realty Co. & Agent / Address / Zip Code Phone Legal Descriptbn 1 r:4- I_ f/3, 13 Jc k 3 1 -TE, r 4 C i Street Location IA t 1,,v,. , lir, ^ Ki (6 , 6ly- Type of Residence Single Family ❑ Multiple Family No. of Bedrooms ( APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL• DATE ' '— ')00" ❑ Other Water Supply D Individual 2. Community ❑ Public Utility ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available). Sewer Disposal Individual 4 go 31.01 Utility ❑ Holding Tank Year Individual Installed: /9,' Q- '-a i-sa When Connected to Public Utility Well To Absorption Area Well to Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time`` _,, ^^__ ) lis Citi 1� M11 Date Date Date Date `� \ C- \- SQ. Inspector Inspector Inspector Inspe ctor\� ICS '4tS Field Notes: MUNICIPALITY OF ANCHORAGE COPT Cr 1 T' 7'1 ^. ENVIk;.dt..I A. .O E TI J ' 2 7 '(9852 RECEIVED ( APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL• DATE ' '— ')00" *CONDITIONS OF APPROVAL Soils Rating / S. Date Sewer Installed 7- / .. f t.- Well To Absorption Area Well to Tank Well Log Received Septic Tank Size / (. e k`a 72-023 (3/82) APPLY .NT FILLS OUT UPPER HA , ONLY Property Owner ..,..rrj- (::( i2 .,' , /4, \t Mailing Address r!/0 .,C 7/141/4)0 -//t. F/ c 62 (./ / ) tl t(14(17/7C t` / i)/`::ij 1 ' : Zip Code t7 9'5- j 7 Phone ;; iv_ f- 6 Buyer Address Zip Code Lending Institution 4 /, /1,57e a 6U;;,5, Address /' (, r,. 4:'4!x% J (,, %t//!.'/t) >p //L i `: /( "s i! JZip Code ' "7_`i" Phone Realty Co. & Agent Address Zip Code Phone Legal Description 40 T 1 j Y3 61- Street Location 3 43 i• .t 4)0 tC 1) (.a /3. r / -. ' s- Type of Residence ."Single Family ❑ Multiple Family No. of Bedrooms ❑ Other j tSv�c) C--- .1 E (( APPROVED BEDROOMS ( DISAPPROVED ( ) CONDITIONAL APPRQVAL' DATE L[�,,�'� Water Supply ❑ Individual clcE_ ( grt.Community--_-- 0 Public Utility r r, 3/4t'+^ , _ ATTifiCH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log If available). Sewer Disposal Individual ❑ Public Utility 0 Holding Tank Year Individual Installed: / ti2. When Connected to Public Utility: Well To Absorption Area Well to Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date DateDate Date `` uLAID Inspector Inspector Inspector Inspeector� ^ (, LA�1 U V A S Field Notes: ,� E i . S C0�,,.-c t� ct MUNICIPALITY OF ANCHORAGE 6-0421 DEPT. OF t1El:LTt'1 et ENVIRONtv1=NTAL PROTECTION 1 RECEIVED, tSv�c) C--- .1 E (( APPROVED BEDROOMS ( DISAPPROVED ( ) CONDITIONAL APPRQVAL' DATE L[�,,�'� *CONDITIONS OF APPROVAL BY: 7e -A03 "" Soils Rating Date Sewer Installed -- Well To Absorption Area Well to Tank /1n. fes- Well Log Received Septic Tank Size / ? 0 0 72.023 (3182) Please READ HANDLE APPROVE and Date Scotsr 7664 "Post -it" Routing -Request Pads ROUTING - REQUEST To AA( if �sEc )1 1 FORWARD , IA Ofrt-0^4,--&--00— RETURN KEEP OR DISCARD l7f )14 @ e REVIEW WITH ME From January 19, 191 Stuart Jacques 9102 Hiland Road Eagle River, AK 99577 :..)ubject Lot 1, 1 , lilock 3, Bernard Subdivision Approval tor the individual sewer and water facilities cannot be granted until the following items have been completed: ° Submit a letter from the State D.1;.C. showing that the com- munity water system is current with the sampling schedule. You can call rir. Hike Mathews at 274-2533. Please notify this Department for a reinspection when the noted discrepancies have been corrected. It there are any further questions, please call this office at 264-4720. Sincerely, Cory Willis, A.S. Acting Sewer Water Program Hanager CW97/ej/E1 Parcel I.D. 060-321-16 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: Complete legal description Bernard, Block 3, LotI 1 B Location (site address) 8164 Stewart Mountain Drive Eagle River, AK 99577 Current Property owner(s) Roy J. Thomas Day phone P.O. Box 772026 Eagle River, AK 99577 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: E Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 9 Individual (] Individual Water Storage ❑ Holding Tank ❑ Community Class Well 9 Community 9 Public Water System 9 Public Sewer ❑ Waiver/Variance request for: Distance: Received COSA to be released o the ineer, unless otherwise requested by the engineer. Date: & COSA Fee $ $24 - Date of Payment (o ir I IT Receipt Number 6.3l0C\ COSA# OSC15 t24S Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, sho (hat the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for trilhartibef of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(arej in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE ✓ System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval, for Phone 522-7773 Date 6/8/2015 .ate?•OF.A< 11 44 1.11 a*: 49rH C57:1444* ollsora..micHA ERSON 1,1,7 �i;if S- ®. bedrooms, with the following stipulations: ,..tsc�tOF ANcj r,�± ON-StR` WNIER AND 1a WASE WASER J� PROGRAM Ji)ENT SL�`vN`,'NN \, ))l))))))F00v By: The Municipality of Anc orage Development Services. Division (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. Original Certificate Date: ?/,3/75 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_: -. If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Bernard, Block 3, Lot 1-1 B Parcel ID: 060-321-16 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (YIN) Date completed 5- &/144oc33. a seal (Y/N) Y Wires properly protected (Y/N) ¥ Total depth 160 ft. Cased to 60 ft. Casing height (above ground) >18 in. FROM WELL LOG Date of test -6/9/86 (°/jq/ofo g Static water level 39 ft. Well production 30 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 1.43 mg/L Arsenic ND ug/L Date of sample: 5/21/15 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal Number of Compartments 2 Foundation cleanout (Y/N) Y Date of pumping 9/23/14 Depression over tank (Y/N) N Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 7/21/82 AT INSPECTION 3/31/15 29 6.7 g.p.m. ft. Collected by: Anderson Engrg. Date installed 7/21/82 Cleanouts (WN) Y High water alarm (Y/N) N p p 175 SF/BERM Soil rating (g.p.d./ft or ft/bdrm) System type Deep Trench Length 44 ft. Width 4 ft. Gravel below pipe Total depth10 ft. Eff. absorption area 528 ftz Date of adequacy test 3/31/15 Results (Pass/Fail) Pass Fluid depth in absorption field before test 26 in. Water added 610 Elapsed Time: 1,440 min. Final fluid depth26 in. Absorption rate >= 450 6 Monitoring tube Y Depression over field N ft. For 4 bedrooms gal. New depth 48`5 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N if yes, give date g.p.d. D. LIFT STATION No Add On Manhole - Gravity Flow to Absorption Trench. Date installed "Pump on" level at in. "Pump off" level at Datum Cycles tested Size in gallons E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on at Public sewer main Sewer /septic service line >25' Animal containment areas >50' SEPTIC/HOLDING TANK ON LOT TO: >100' >100' >75' in. Building foundation >5' Property line >5' Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots >100' in. On adjacent lots >100' Public sewer manhole/cleanout Holding tank >75' >100' Manure/animal excrete storage areas >100' Absorption field >5' '- >100' Water main >10' Water service line >10' Surface water Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10' Water Service line >10' Curtain drain None Noted Building foundation >10 Water main ID' Surface water >100' Wells on adjacent lots >1001 Driveway, parking/vehicle storage of F. COMMENTS Entire absorption trench is located under the driveway. Septic system has been in service for 33 years. G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineers Printed Name Michael E. Anderson, P.E. Date 6/8/2015 COSA brown sheet 10-10-12.doc ®��,aae►a*111 ..®"�.9 f..11(q tot TH IA'a% MICHAEL E. ANDERSON• f'• CE -4381 :tet i #T9••— ;•�s II N, 6S %: ASBUILT-NO CORNERS SET THIS DATE. HEREBY CERTIFY THAT I HAVE SURVEYED THE =OLLOWING DESCRIBED PROPERTY; Lot I -1B, clock 3, Bernard Subdivision IND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE 7WNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI /ISION PLAT. UNDER NO CIRCUMSTANCES SHOULD WY DATA HEREON BE USED FOR CONSTRUCTION )F FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. ;ALE' 1" = 30' DATE' 4/29/92 GRID: SW254 FBl 28-36 DRAWN; DMS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # (-Nr - 11 n 1. GENERAL INFORMATION HAA#caLai.. Complete legal description Lot I1B; Block 3; Bernard Subdivision Location (site address or directions) 9102 Hiland Road, Eagle River, Alaska Property owner Stewart and Alexis Jacques Day phone 688-6595 Mailing address 9102 Hiland Road, Eagle River, Alaska 99577 Lending agency Day phone Mailing address Agent Lynda Banner - RE/MAX OF EAGLE RIVER Day phone 694-4200 Address 16600 Centerfield Drive, Suite 201, Eagle River, Alaska 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX NOTE: If community well system, provide written confirmation from State ADEnttest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 921 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENCINECRING 17034 Eagle River Loop Road No. 204 Address Cagle River, Alaska 99577 Phone Engineer's signature Date � 1-."I 2- 6. 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By. :, bF �4(, `tgtp1 > %D 0* 149 w ..i.••� A.. .0.•.s a.�• .iBOGER J tvf tAFEf 0 it .Y 74 t;.� *d N o. 215 . e.: ,ny 'Cea p -s "*•04toxe,A�L ar Additional Comments -n rz5/ _ Date V/#'t- ' CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 'r ' 1e, t771 -v- 3 LSD Parcel I D a''37 -/6 so A. WELL DATA Well type /f� � If A, B, or C, attach ADEC letter. ADEC water system number -2-‘17154--- Log 21S9'" -- Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: c' Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line gpm AT INSPECTION {.r rti• ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by. B. SEPTIC/HOLDING TANK DATA Date installed 7' Z-1 6Z Cleanouts Z'N) High water alarm (Yt Date of pumping 1 -- 1'2---`11 — Tank size 1 °00 - Compartments Foundation cleanout 15/N) Depression (Yj h' Alarm tested (Y/N) 1/ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot�a- 1><1-1 lT iP-tz 'PUNA 176? - On adjacent lots ', Foundation I To property line o I+r Absorption field 5 Water main/service line Surface water/drainage 1 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical code SEPARATI (STANCE FROM LIFT STATION TO: I on lot On adjacent Tots Surface water D. ABSORPTION FIELD DATA Date installed 1 '21'82 Soil rating 1'I `3/62- System type 'C -R-..4 Length 9'`t Width 4Gravel thickness La Total depth 10 Cleanouts present 'N) V Depression over field (Y/64 rd Date of adequacy test ~ t -°1-2- " Total absorption area Results 41ail) "5 Peroxide treatment (past 12 months) (Y4 for -rkig-r- 0) rAc. 1L.11)%4 J If yes, give date 4 bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ok On adjacent lots 'S1 ti Property line ID "+ To building foundation '2-sIA- To existing or abandoned system on lot �`�ll>. On adjacent lots k Cutbank p� Water main/service line ,o Surface water 1 t7 Driveway, parking/vehicle storage area S Curtain drain ''� �t?► E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. � QF ��A S & S ENGINEERING wk@� •e'®0-01"-;^.' . �e Signature 17034 Eagle River Loop Road No. 204 fir ;' `a"9 Eagle River, Alaska 99577 0 It �.!',,. ?'. i"'} •� k 414, Engineer's Name Date ' 2— 12 V. 1.11 s� N fair �n o¢ ry HAA Fee $ /20' Waiver Fee• $ Date of Payment /7i" ` Date of Payment Receipt Number a 3 57 9 CGli6'/ Receipt Number 72-026 (Rev. 3/91) Back MOA 21 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 FOR: S & S Engineering March 31, 1992 PWSID # 212754 WALTER J. NICKEL, GOVERNOR (907) 349-7755 My review of the records on file in this office reveals that the Stewart Water System, Class "A" Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer II BR/cf t, y SECT05 24 389°68'30 'w 473.28._56,../MEA_ z c ICEIw 05 '0 2CC.O LOT 10 53,000 S.F. 1.217 AC. 207 X' E.4 355 710 t 1 78.25 0 0 I.s LOT 11 53,000 S.F • 2!7.40. WEST /4 0095ER SEC7^ON ;9 I S 24 5.9 CN:ND C.9', = GRG�`fC NOTES 7 '\ TRACT L -I 145,130 S.F. 3.332 AC. 200.00 • 200.00 /",� S89°56'30"478 204.24MEA./ 120 OOREC. (71-193) BASIS OF BEARING HILAND ROAD (Platted) 1. 5/8" 2E5:..R SET 05 000 CORNERS ;,5023_ GTCER'N;sE NOTED. 2_ LOCaTNON 07 ASN 4N;, .,,,.,LEO FROM PLAT 7H;93 SU,R VEYOR'S CERT/ FICA TE GARY R. SOCK professional land surveyor do hereby certify that the plat of THIS PLAT is a true and correct representation of ;ands actually surveyed and that the distances and bearings are shown correctly and that al/ permanent exterior control monuments, ail 07her monuments, and lot corners have been set and staked o, if ,;nal completion is assured by subdivision agreement, they vii11 be set as specified ;n said subdivision agreement. Lot corners to be set by N/A Monuments to be set by :N/A PLAT APPROVAL P/at approved by the Pvrunicipai Platting Authority Mrs jlfr,day of 1911 AfE SUPPLIES 146036 77E - ROY! ' 50-7579 :093E0 .5 =:3028 590002 LEGEND N S E RE565 (71-193. G, c _;;SENtENT /�. •• 93.997850./.9388x550 -33% S89°56 30 W(TH93) !�o 'v 792 TR3 31 ROW OfI z: N. S:;e i 50 a5013 3205.ND 3.5. 2 12' DIS. 9RASS C_P r \� d=i•;_ • EX:207G 2 DN:, 95523 D.., '/05555747 U 2 ''/2" °s, POS- .. EX:ST:NS IRON 9,p5 • 5/8" RE5,05 280 _',_,IS 502-_ ACCEPTANCE OF DED/CAT/071 The Municipality of Anchorage hereby accepts for pubhc uses and for pubilc purposes the real property dedicated on this plat i, c.uding, but not limited to the easements, richts-ofhpay, a/leis, roadways, thoroughfares and parks 5008/11 hereon ,_ESS 085331:35 N3050) "SOUND arc 91- -1 DS fh'enorart e. 1-2-119 10:54 A ql OAX CERT/FICA7/Ohi Ail real property taxes levied by the Municipality of Anchorage on the area shown 0,7 0/710 plat have been paid APPROVALS Save. k. cat= 11,411 1001 CER 1 /F/CA7E OF OWNERSHIP and DEDICATION / (vie), hereby certify that 1 (we) hold the herein specified property interest in the property described hereon. I (we) hereby dedicate to the Municipality of Anchorage ail areas depicted for use as public utility easements, streets, alleys, thoroughfares, parks, and other public areas shown hereon_ There shall be reserved adjacent to the dedicated streets 5170011) hereon, a slope reservation easement sufficient to contain cut and fill slopes of 1.5 feet horizontal for each 1 foot vertical (1,5 to 7) of cut or fill for the purpose of providing and maintaining the lateral support of the constnfcted streets. There is reserved to the grantors, their heirs, successors and assigns, the right to use such areas at any time upon providing and maintaining other adequate latera/ support, as approved 5/ the Municipality. I (we) hereby agree to this plat, and to any restriction or covenant appearing hereon and any such restriction or covenant shall be binding and enforceable against present and successive owners of this subdivided property. NER oernard Stewart :';"22'11;:''0141-6\77.SS?ewer'. HC85 Bcx 9.-00 HC85 Sox 9)00 0agle Ri537, A(eska 99577 Eagle River, Akoska 99577 P,lOT,4RY:;C,'CflOWLEOG_,u"ff ;214 e D•S sRf'+f& Subscribed and sworn to before ma *h:s 59 /lay o`OG-lo -h 799/ 1 trIC/N"'Y MAP SCALE: ) 505__ 5.588 5050 2/ 130S 24 24 ;9 RC8G 905 :THIS PLAT/91/T75 8 I6 .T 9 20 23';24 24 19 19 ',20 20 26,25 25,30 50,29 29, ANCHORAGE RECORDING DISTRICT PLAT OF BERNARD SUBDIVISION TRACT L-1, LOTS 10 AND 11, BLOCK 3 A SUBDIVISION OF BERNARD SUBDIVISION, TRACT L, BLOCK 3 (71-193) 5.77ACRES LOCATED WITHIN NW I/4SEC. 19, 7)4N, RIW, S.M. GARY R. BOCK — RLS 301 DANNER AVE. ANCHORAGE, AK 995)8 G, -Id SW 254 Scale 0,73 2300791 arc- 9,-0! 2,99 2 Drac�n HKS /./ Pio S-90$9